Chapter 3. Medical Nutrition Therapy Benefit
Medicare began offering a diabetes self-management training benefit in 2002. This benefit is available under Medicare Part B (part of “original Medicare”).
The Part B benefit provides payment for:
- Up to 10 hours of DSMT during the initial 12-month period following the submission of the first claim for this benefit.
- One hour of individual training, which may include insulin training and is part of the initial 12 month period’s 10 hour benefit limit.
- Up to 2 hours of DSMT for every 12-month period following the initial period.
- The above training can be performed in any combination of 1/2 hour increments.
Three important conditions apply to Part B DSMT benefits:
- Prior to receiving the initial and follow-up training, the beneficiary must have:
- a diagnosis of diabetes, and
- a written referral from a physician or other qualified medical provider including a nurse practitioner or physician assistant.
- CMS accepts requests for reimbursement for DSMT only from DSMT programs that have achieved accreditation from AADE or ADA.
- Once accreditation has been achieved, the Medicare provider must submit a copy of the accreditation certificate to CMS along with the Medicare provider status and National Provider Identification Number so that the DSMT program can be officially recognized by Medicare.
The referring medical provider, the licensed instructor, and the support staff all make up the multi-disciplinary team that are working in a collaborative manner to improve the overall health of patients with diabetes. An essential member of a multidisciplinary team is one licensed professional, who is called the primary qualified instructor. A primary qualified instructor must be a:
- Registered Nurse, or
- Registered Dietitian, or
- Registered Pharmacist
In addition to the qualified professional, a program should consider using community health workers as part of the multi-disciplinary team.
If a DSMT program is in a designated rural area, then Medicare will allow a registered dietitian to provide DSMT and receive Medicare reimbursement on his/her own, without the use of a multi-disciplinary team.
The Medical Nutrition Therapy (MNT) benefit is a complementary service to DSMT that registered dietitians or nutrition professionals can provide to persons with diabetes. This Medicare Part B benefit covers comprehensive nutrition therapy to foster behavior change. MNT provides 3 hours of individualized care during the first 12 month period following initiation of services.
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